Cross‐sectional multicenter observational study of psoriatic arthritis in Japanese patients: Relationship between skin and joint symptoms and results of treatment with tumor necrosis factor‐α inhibitors

Abstract

Psoriatic arthritis (PsA) is an inflammatory arthritis with as yet unclear pathophysiology. This retrospective, multicenter, cross‐sectional study was conducted in 19 facilities in western Japan and aimed to identify patients’ characteristics and factors that affect the results of treatment with biologic agents. Of 2116 patients with psoriasis, 285 (13.5%) had PsA. Skin manifestations preceded joint manifestations in 69.8%, the onset was simultaneous in 17.2%, whereas PsA preceded skin manifestations in 2.5%. Peripheral arthritis was most common, occurring in 73.7%, compared with axial disease in 21.8%, enthesitis in 23.5% and dactylitis in 35.4%. Patients with severe skin manifestations were significantly younger at onset (P = 0.02) and more frequently had axial disease (P < 0.01). Biologic agents were used in 206 patients (72.3%), anti‐tumor necrosis factor (TNF)‐α antibodies being prescribed first to 157 of them. Anti‐TNF‐α antibodies were continued by 105 participants and discontinued by 47, the remaining five patients being lost to follow up. Patients who discontinued anti‐TNF‐α antibodies were significantly older than those who continued (55 vs 51 years, P = 0.04) and significantly older at onset of joint manifestations (50 vs 44 years, P = 0.01). Multivariate analysis revealed that patients over 50 years significantly more frequently terminated anti‐TNF‐α antibodies (P < 0.01). In conclusion, patients with PsA and severe skin manifestations have earlier onset and axial disease, which seriously impacts on quality of life. Anti‐TNF‐α antibodies were generally effective enough to continue but less so in patients aged over 50 years. Further detailed research is needed.

Aryl Hydrocarbon Receptor in Atopic Dermatitis and Psoriasis

“…The cosmetic disfigurement associated with psoriasis profoundly impairs the patients’ quality of life, treatment satisfaction and adherence, and socioeconomic stability [114,115]. The autoimmune nature of psoriasis is exemplified by its high comorbidity with psoriatic arthritis [110,116,117,118] and other autoimmune diseases including autoimmune bullous diseases [119,120,121,122,123,124]. Psoriasis is also comorbid with cardiovascular diseases, metabolic diseases, and renal disorders, which represent a condition called inflammatory skin march [111,125,126,127,128,129].…”

Pathogenic implication of epidermal scratch injury in psoriasis and atopic dermatitis

“…[30][31][32] Due to a profound cosmetic burden, patients' quality of life, treatment satisfaction and adherence, and social activities are deteriorated by psoriasis. 30,33 Psoriasis is considered as an autoimmune or autoinflammatory disease with high rate of comorbidities, including psoriatic arthritis 30,[34][35][36] and other autoimmune diseases such as autoimmune bullous diseases. 32,[37][38][39][40] Comorbid conditions of psoriasis further comprise cardiovascular diseases, metabolic diseases and renal disorders, collectively called the inflammatory skin march.…”

Interleukin-17A and Keratinocytes in Psoriasis

“…That the tumor necrosis factor-α (TNF-α) and IL-23/IL-17A axes appear to be major drivers in the pathogenesis of psoriasis is underscored by the excellent response of psoriasis to biologics targeting TNF-α, IL-23, and IL-17A, although a difference exists in their efficacy [46][47][48][49][50][51][52][53][54][55][56][57][58][59][60][61]. Anti-TNF-α/IL-23/IL-17A biologics successfully improve psoriatic arthritis [18,56,[62][63][64].…”